Provider Demographics
NPI:1922152636
Name:ADDASI, TALAT F (MD)
Entity Type:Individual
Prefix:DR
First Name:TALAT
Middle Name:F
Last Name:ADDASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-539-7230
Mailing Address - Fax:718-460-6869
Practice Address - Street 1:14243 BOOTH MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5343
Practice Address - Country:US
Practice Address - Phone:718-539-7230
Practice Address - Fax:718-460-6869
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139806208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400001906OtherMEDICARE PTAN
NY79480OtherMEDICARE LEGACY NUMBER
NYG400001906OtherMEDICARE PTAN